• Increased osteoclastic activity (Malignancy, hyperparathyroidism)
  • Decreased renal calcium excretion (hyperparathyroidism, renal failure Drugs (Thiazides, vitamin D, Lithium)
  • Other (Sarcoidosis, TB, over ingestion of calcium / vit D, hyperthyroidism)


  • GI upset (anorexia, N&V, constipation)
  • CVS effects (hypertension , short QT)
  • Renal (polydipsia, polyuria)
  • CNS (depression, psychoses, fitting, coma)

Palliative Care Agreed Management of Hypercalcaemia
Management hypercalcaemia


  1. Hydration (N. saline)
  2. Enhance renal excretion ( add 40mg Frusemide once patient adequately rehydrated)
  3. Inhibit bone re-absorption (bisphosphonates, particularly in malignancy)
  4. Treat underlying problem  and (consider steroids in sarcoidosis, vit D toxicity, haematological malignancies)


Re Zoledronic acid

  1. Green J et al. (1994) Preclinical pharmacology of CGP 42'446 a new, potent, heterocyclic bisphosphonate compound. Journal of Bone and Mineral Research. 9: 745-751.
  2. Body J (1997) Clinical research update: zoledronate. Cancer. 80: 1699-1701.
  3. Major P et al. (2001) Zoledronic acid is superior to pamidronate in the treatment of hypercalcaemia of malignancy. a pooled analysis of two randomized, controlled clinical trials. Journal of Clinical Oncology. 19: 558-567.
  4. Cheer S and Noble S (2001) Zoledronic acid. Drugs. 61: 799-805.
  5. Lee M et al. (2001) Bisphosphonate treatment inhibits the growth of prostate cancer cells. Cancer Researchp. 61: 2602-2608.
  6. Berenson J et al. (2001) Zoledronic acid reduces skeletal-related events in patients with osteolytic metastases. Cancer. 91: 1191-1200.
  7. Fleisch H (1998) Bisphosphonates: mechanisms of action. Endocrine Reviews. 19: 80-100.

Content by Dr Íomhar O' Sullivan 16/06/04. Reviewed by Dr ÍOS 15/05/2005, 26/05/2006, 22/08/2006. Next review 22/08/2007.